Med Surg Chapter 34

A nurse is working with a client with rheumatic disease who is being treated with salicylate therapy. What statement would indicate that the client is experiencing adverse effects of this drug? A. "I have this ringing in my ears that just won't go away." B. "I feel so foggy in the mornings and it takes me so long to wake up." C. "When I eat a meal that's high in fat, I get really nauseous." D. "I seem to have lost my appetite, which is unusual for me."

A. "I have this ringing in my ears that just won't go away."

A client is undergoing diagnostic testing to determine the etiology of recent joint pain. The client asks the nurse about the difference between osteoarthritis (OA) and rheumatoid arthritis (RA). What is the best response by the nurse? A. "OA is considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." B. "OA and RA are very similar. OA affects the smaller joints such as the fingers, and RA affects the larger, weight-bearing joints like the knees." C. "OA originates with an infection. RA is a result of your body's cells attacking one another." D. "OA is associated with impaired immune function; RA is a consequence of physical damage."

A. "OA is considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."

A client with an exacerbation of systemic lupus erythematosus (SLE) has been hospitalized on a medical unit. The nurse observes that the client expresses anger and irritation when the call bell isn't answered immediately. Which response would be the most appropriate? A. "You seem like you're feeling angry. Is that something that we could talk about?" B. "Try to remember that stress can make your symptoms worse." C. "Would you like to talk about the problem with the nursing supervisor?" D. "I can see you're angry. I'll come back when you've calmed down."

A. "You seem like you're feeling angry. Is that something that we could talk about?

A client has a diagnosis of rheumatoid arthritis, and the primary provider has now prescribed cyclophosphamide. The nurse's subsequent assessments should address which potential adverse effect? A. Bone marrow suppression B. Acute confusion C. Sedation D. Malignant hyperthermia

A. Bone marrow suppression

A nurse is planning the care of a client who has a long history of chronic pain, which has only recently been diagnosed as fibromyalgia. Which nursing diagnosis is most likely to apply to this client's care needs? A. Ineffective role performance related to pain B. Risk for impaired skin integrity related to myalgia C. Risk for infection related to tissue alterations D. Unilateral neglect related to neuropathic pain

A. Ineffective role performance related to pain

A client has been admitted to a medical unit with a diagnosis of polymyalgia rheumatica (PMR). The nurse should be aware of which aspects of PMR? Select all that apply. A. PMR has an association with the genetic marker HLA-DR4. B. Immunoglobulin deposits occur in PMR. C. PMR is considered to be a "wear-and-tear" disease. D. Foods high in purines exacerbate the biochemical processes that occur in PMR. E. PMR occurs predominately in Caucasians.

A. PMR has an association with the genetic marker HLA-DR4. B. Immunoglobulin deposits occur in PMR. E. PMR occurs predominately in Caucasians.

A client with a history of arthritis is being discharged to home after right wrist surgery, and the nurse reviews nonopioid pain relief measures. Which intervention(s) would best address the needs of this client? Select all that apply. A. Paraffin bath B. Nonsteroidal anti-inflammatory drugs (NSAIDs) C. Rolling walker D. Antiepileptic medications E. Splint or brace

A. Paraffin bath B. Nonsteroidal anti-inflammatory drugs (NSAIDs) E. Splint or brace

The nurse is preparing to care for a client who has scleroderma. The nurse refers to resources that describe CREST syndrome. Which condition is a component of CREST syndrome? A. Raynaud phenomenon B. Thyroid dysfunction C. Esophageal varices D. Osteopenia

A. Raynaud phenomenon

A client's decreased mobility has been attributed to an autoimmune reaction originating in the synovial tissue, which caused the formation of pannus. This client has been diagnosed with which health problem? A. Rheumatoid arthritis (RA) B. Systemic lupus erythematosus (SLE) C. Osteoporosis D. Polymyositis

A. Rheumatoid arthritis (RA)

A nurse is performing the initial assessment of a client who has a recent diagnosis of systemic lupus erythematosus (SLE). Which skin manifestation would the nurse expect to observe on inspection? A. Petechiae B. Erythematous rash C. Jaundice D. Skin sloughing

B. Erythematous rash

A nurse is caring for a client who is suspected of having giant cell arteritis (GCA). Which laboratory tests are most useful in diagnosing this rheumatic disorder? Select all that apply. A. Erythrocyte count B. Erythrocyte sedimentation rate C. Creatinine clearance D. C-reactive protein E. D-dimer

B. Erythrocyte sedimentation rate D. C-reactive protein

A client with polymyositis is experiencing challenges with activities of daily living as a result of proximal muscle weakness. What is the most appropriate nursing action? A. Initiate a program of passive range of motion exercises B. Facilitate referrals to occupational and physical therapy C. Administer skeletal muscle relaxants as prescribed D. Encourage a progressive program of weight-bearing exercise

B. Facilitate referrals to occupational and physical therapy

A client who was just diagnosed with scleroderma will be undergoing tests to assess for systemic involvement. Which system should the nurse prioritize in assessment? A. Hepatic B. Gastrointestinal C. Genitourinary D. Neurologic

B. Gastrointestinal

A client with a documented history of allergies presents to the clinic. The client reports being frustrated by chronic nasal congestion, anosmia (inability to smell), and inability to concentrate. The nurse should identify which nursing diagnosis? A. Deficient knowledge of self-care practices related to allergies B. Ineffective individual coping with chronicity of condition C. Acute confusion related to cognitive effects of allergic rhinitis D. Disturbed body image related to sequelae of allergic rhinitis

B. Ineffective individual coping with chronicity of condition

A nurse is providing care for a client who has just been diagnosed with early-stage rheumatoid arthritis (RA). The nurse should anticipate the administration of which medication? A. Hydromorphone B. Methotrexate C. Allopurinol D. Prednisone

B. Methotrexate

A client with rheumatoid arthritis comes to the clinic reporting pain in the joint of his right great toe and is eventually diagnosed with gout. When planning teaching for this client, what management technique should the nurse emphasize? A. Take OTC calcium supplements consistently. B. Restrict consumption of foods high in purines. C. Ensure fluid intake of at least 4 L per day. D. Restrict weight-bearing on right foot.

B. Restrict consumption of foods high in purines

A nurse is providing care for a client who has a rheumatic disorder. The nurse's focused assessment includes the client's mood, behavior, level of consciousness, and neurologic status. Which diagnosis is most likely for this client? A. Osteoarthritis (OA) B. Systemic lupus erythematosus (SLE) C. Rheumatoid arthritis (RA) D. Gout

B. Systemic lupus erythematosus (SLE)

A client has just been diagnosed with a spondyloarthropathy. Which nursing intervention should the nurse prioritize? A. Referral for assistive devices B. Teaching about symptom management C. Referral to classes to stop smoking D. Setting up an exercise program

B. Teaching about symptom management

A nurse is planning client education for a client being discharged home with a diagnosis of rheumatoid arthritis. The client has been prescribed antimalarials for treatment, so the nurse knows to teach the client to self-monitor for what adverse effect? A. Tinnitus B. Visual changes C. Stomatitis D. Hirsutism

B. Visual changes

A client with systemic lupus erythematosus (SLE) is preparing for discharge. The nurse knows that the client has understood health education when the client makes what statement? A. "I'll make sure I get enough exposure to sunlight to keep up my vitamin D levels." B. "I'll try to be as physically active as possible between flare-ups." C. "I'll make sure to monitor my body temperature on a regular basis." D. "I'll stop taking my steroids when I get relief from my symptoms."

C. "I'll make sure to monitor my body temperature on a regular basis."

A 68-year-old client with a history of rheumatic disease has persistent swelling, no stiffness, and full range of motion to his left knee after an injury sustained several months ago. X-rays reveal no fracture of the extremity. Which factor is the most likely cause of the client's continued swelling? A. Degradation of cartilage B. Aging C. An inflammation process D. Reinjury not seen on x-ray results

C. An inflammation process

A client with rheumatoid arthritis comes into the clinic for a routine check-up. On assessment the nurse notes that the client appears to have lost some ability to function since the last office visit. What is the nurse's most appropriate action? A. Arrange a family meeting in order to explore assisted living options. B. Refer the client to a support group. C. Arrange for the client to be assessed in the home environment. D. Refer the client to social work.

C. Arrange for the client to be assessed in the home environment.

A clinic nurse is caring for a client with suspected gout. While describing the pathophysiology of gout to the client, what should the nurse explain? A. Autoimmune processes in the joints B. Chronic metabolic acidosis C. Increased uric acid levels D. Unstable serum calcium levels

C. Increased uric acid levels

A nurse is performing the health history and physical assessment of a client who has a diagnosis of rheumatoid arthritis (RA). What assessment finding is most consistent with the clinical presentation of RA? A. Cool joints with decreased range of motion B. Signs of systemic infection C. Joint stiffness lasting longer than 1 hour, especially in the morning D. Visible atrophy of the knee and shoulder joints

C. Joint stiffness lasting longer than 1 hour, especially in the morning

A nurse is educating a client with gout about lifestyle modifications that can help control the signs and symptoms of the disease. What recommendation should the nurse make? A. Ensuring adequate rest B. Limiting exposure to sunlight C. Limiting intake of alcohol D. Smoking cessation

C. Limiting intake of alcohol

A nurse is creating a teaching plan for a client who has a recent diagnosis of scleroderma. Which topics should the nurse address during health education? Select all that apply. A. Surgical treatment options B. Weight loss C. Management of Raynaud-type symptoms D. Exercise E. Skin care

C. Management of Raynaud-type symptoms D. Exercise E. Skin care

A client with systemic lupus erythematosus (SLE) asks the nurse why the client has to come to the office so often for "check-ups." Which rationale for frequent office visits would be best for the nurse to mention? A. Seeing the client face to face B. Ensuring that the client is taking medications as prescribed C. Monitoring the disease process and how well the prescribed treatment is working D. Drawing blood work every month

C. Monitoring the disease process and how well the prescribed treatment is working

A client is diagnosed with giant cell arteritis (GCA) and is placed on corticosteroids. A concern for this client is that the client will stop taking the medication as soon as the client starts to feel better. The nurse must emphasize the need for continued adherence to the prescribed medication so that the client can avoid which complication? A. Venous thromboembolism B. Osteoporosis C. Degenerative joint disease D. Blindness

D. Blindness

Allopurinol has been prescribed for a client receiving treatment for gout. The nurse caring for this client knows to assess the client for bone marrow suppression, which may be manifested by what diagnostic finding? A. Hyperuricemia B. Increased erythrocyte sedimentation rate C. Elevated serum creatinine D. Decreased platelets

D. Decreased platelets

A clinic nurse is caring for a client newly diagnosed with fibromyalgia. When developing a care plan for this client, which nursing diagnosis should the nurse prioritize? A. Impaired urinary elimination related to neuropathy B. Altered nutrition related to impaired absorption C. Disturbed sleep pattern related to central nervous system stimulation D. Fatigue related to pain

D. Fatigue related to pain

A community health nurse is performing a visit to the home of a client who has a history of rheumatoid arthritis (RA). On which aspect of the client's health should the nurse focus most closely during the visit? A. Understanding of rheumatoid arthritis B. Risk for cardiopulmonary complications C. Social support system D. Functional status

D. Functional status

A nurse is providing care for a client who has a recent diagnosis of giant cell arteritis (GCA). Which aspect of physical assessment should the nurse prioritize? A. Subtle signs of bleeding disorders B. The metatarsal joints and phalangeal joints C. Thoracic pain that is exacerbated by activity D. Headaches and jaw pain

D. Headaches and jaw pain

A nurse is assessing a client with rheumatoid arthritis. The client expresses the intent to pursue complementary and alternative medicine (CAM) therapies. Which fact should underlie the nurse's response to the client? A. New evidence shows CAM to be as effective as medical treatment. B. CAM therapies negate many of the benefits of medications. C. CAM therapies typically do more harm than good. D. Most CAM therapies lack sufficient evidence to support them.

D. Most CAM therapies lack sufficient evidence to support them

A nurse's plan of care for a client with rheumatoid arthritis includes several exercise-based interventions. What goal should the nurse prioritize? A. Maximize range of motion while minimizing exertion. B. Increase joint size and strength. C. Limit energy output in order to preserve strength for healing. D. Preserve or increase range of motion while limiting joint stress.

D. Preserve or increase range of motion while limiting joint stress.

A client with rheumatic disease has developed a gastrointestinal (GI) bleed. The nurse caring for the client should further assess for medications that typically exacerbate this condition. Which medication applies? A. Corticosteroids B. Immunomodulators C. Antimalarials D. Salicylate therapy

D. Salicylate therapy

A 40-year-old woman was diagnosed with Raynaud phenomenon several years earlier and has sought care because of a progressive worsening of her symptoms. The client also states that many of her skin surfaces are "stiff, like the skin is being stretched from all directions." The nurse should recognize the need for medical referral for the assessment of what health problem? A. Giant cell arteritis (GCA) B. Fibromyalgia (FM) C. Rheumatoid arthritis (RA) D. Scleroderma

D. Scleroderma

A client's rheumatoid arthritis (RA) has failed to respond appreciably to first-line treatments and the primary provider has added prednisone to the client's drug regimen. What principle will guide this aspect of the client's treatment? A. The client will need daily blood testing for the duration of treatment. B. The client must stop all other drugs 72 hours before starting prednisone. C. The drug should be used at the highest dose the client can tolerate. D. The drug should be used for as short a time as possible.

D. The drug should be used for as short a time as possible.